Medical Director- Kansas Medicaid

About the position The Medical Director for Kansas Medicaid at Elevance Health is responsible for overseeing the administration of physical and behavioral health medical services, ensuring that members receive appropriate and cost-effective medical care. This role involves developing and implementing programs aimed at improving quality, cost, and outcomes, as well as providing clinical consultation and strategic advice to enhance clinical operations. The Medical Director may also identify cost-saving opportunities and serve as a resource for staff, including Medical Director Associates, while managing entire clinical programs. Responsibilities • Support clinicians to ensure timely and consistent responses to members and providers. , • Provide guidance for clinical operational aspects of a program. , • Conduct peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations and patients' office visits. , • Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers. , • Serve as a resource and consultant to other areas of the company. , • Represent the company to external entities and/or serve on internal and/or external committees. , • Chair company committees as needed. , • Interpret medical policies and clinical guidelines. , • Develop and propose new medical policies based on changes in healthcare. , • Lead, develop, direct, and implement clinical and non-clinical activities that impact healthcare quality, cost, and outcomes. , • Identify and develop opportunities for innovation to increase effectiveness and quality. Requirements • MD or DO with Board certification approved by ABMS or AOA. , • Active unrestricted medical license to practice in Kansas. , • Minimum of 10 years of clinical experience or equivalent education and experience. , • For Health Solutions and Carelon organizations, minimum of 5 years of experience providing healthcare. Nice-to-haves • Board certification in Internal Medicine, Family Medicine, or Emergency Medicine. , • Medicaid experience. , • Managed Care experience. Benefits • Merit increases , • Paid holidays , • Paid Time Off , • Incentive bonus programs , • Medical insurance , • Dental insurance , • Vision insurance , • Short and long term disability benefits , • 401(k) with matching , • Stock purchase plan , • Life insurance , • Wellness programs , • Financial education resources Apply Job!